Healthcare Provider Details

I. General information

NPI: 1396325759
Provider Name (Legal Business Name): LAURA JANEL REEDY CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA JANEL URBANOWICZ

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

1221 E BROADWAY APT 408
LOUISVILLE KY
40204-2541
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax:
Mailing address:
  • Phone: 404-316-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: